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Abstract
Status epilepticus is defined as generalised convulsions lasting 30 minutes or longer, which are either continuous, or where there is failure regain consciousness between seizures. The longer the time taken to gain control of seizures the worse the neurological outcome for the child and the harder it is to terminate the seizures. The outcome is further influenced by the underlying aetiology. Treatment of status epilepticus consists of four stages - pre-hospital treatment, emergency department, in-hospital treatment (ward or high care) and anaesthesia (ICU). There are numerous protocols available world-wide. Most are based on the available facilities and the anecdotal preferences of the units involved. Beyond the first level of intervention there are no large evidence based guidelines which identify the optimal intervention. Newer agents are increasingly being used, but studies to assess the true efficacy of these are not available. Further, protocols differ between resource poor countries compared to equipped countries where the capacity to provide intensive care support and expensive medical interventions is limited. There are two targets in the management of status epilepticus namely the rapid identification of the underlying aetiology as this affects treatment and prognosis and the early initiation towards terminating status epilepticus which decreases morbidity and mortality.
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References
Zawadzki L, Stafstrom CE (2010) Status epilepticus treatment and outcome in children: what might the future hold? Semin. Pediatr. Neurol. 17 (3):201-5. Crossref Pubmed
Meldrum BS, Vigouroux RA, Brierley JB (1973) Systemic factors and epileptic brain damage. Prolonged seizures in paralyzed, artificially ventilated baboons. Arch Neurol 29 (2):82-7. Pubmed
Lowenstein DH, Bleck T, Macdonald RL (1999) It's time to revise the definition of status epilepticus. Epilepsia 40 (1):120-2. Pubmed
Chin RF, Neville BG, Peckham C, Wade A, Bedford H, Scott RC (2008) Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol 7 (8):696-703. Crossref Pubmed
Scott RC, Surtees RA, Neville BG (1998) Status epilepticus: pathophysiology, epidemiology, and outcomes. Arch Dis Child 79 (1):73-7. Pubmed
Holtkamp M, Othman J, Buchheim K, Meierkord H (2005) Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry 76 (4):534-9. Crossref Pubmed
Schreiber JM, Gaillard WD (2011) Treatment of refractory status epilepticus in childhood. Curr Neurol Neurosci Rep 11 (2):195-204. Crossref Pubmed
Haafiz A, Kissoon N (1999) Status epilepticus: current concepts. Pediatr Emerg Care 15 (2):119-29. Pubmed
Singh RK, Stephens S, Berl MM, Chang T, Brown K, Vezina LG et al. (2010) Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology 74 (8):636-42. Crossref Pubmed
Fountain NB (2000) Status epilepticus: risk factors and complications. Epilepsia 41 Suppl 2 ():S23-30. Pubmed
Lacroix J, Deal C, Gauthier M, Rousseau E, Farrell CA (1994) Admissions to a pediatric intensive care unit for status epilepticus: a 10-year experience. Crit Care Med 22 (5):827-32. Pubmed
Newton CR (2009) Status epilepticus in resource-poor countries. Epilepsia 50 Suppl 12 ():54-5. Crossref Pubmed
Sahin M, Menache CC, Holmes GL, Riviello JJ (2001) Outcome of severe refractory status epilepticus in children. Epilepsia 42 (11):1461-7. Pubmed
Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC et al. (2006) Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 368 (9531):222-9. Crossref Pubmed
Riviello JJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K et al. (2006) Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 67 (9):1542-50. Crossref Pubmed
Kurtz P, Hanafy KA, Claassen J (2009) Continuous EEG monitoring: is it ready for prime time? Curr Opin Crit Care 15 (2):99-109. Crossref Pubmed
Subbaswamy A, Hsu AA, Weinstein S, Bell MJ (2009) Correlation of cerebral Near-infrared spectroscopy (cNIRS) and neurological markers in critically ill children. Neurocrit Care 10 (1):129-35. Crossref Pubmed
Scott RC, Besag FM, Neville BG (1999) Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet 353 (9153):623-6. Crossref Pubmed
Jeannet PY, Roulet E, Maeder-Ingvar M, Gehri M, Jutzi A, Deonna T (1999) Home and hospital treatment of acute seizures in children with nasal midazolam. Eur J Paediatr Neurol 3 (2):73-7. Crossref Pubmed
Loddenkemper T, Goodkin HP (2011) Treatment of pediatric status epilepticus. Curr Treat Options Neurol 13 (6):560-73. Crossref Pubmed
Appleton R, Macleod S, Martland T (2008) Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev (3):CD001905. Crossref Pubmed
Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst. Rev. 2008 Jul 16;(3)(3):CD001905.
Prasad A, Williamson JM, Bertram EH (2002) Phenobarbital and MK-801, but not phenytoin, improve the long-term outcome of status epilepticus. Ann Neurol 51 (2):175-81. Pubmed
Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ et al. (1998) A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 339 (12):792-8. Crossref Pubmed
Wilmshurst JM, van der Walt JS, Ackermann S, Karlsson MO, Blockman M (2010) Rescue therapy with high-dose oral phenobarbitone loading for refractory status epilepticus. J Paediatr Child Health 46 (1-2):17-22. Crossref Pubmed
Syed GB, Sharma DB, Raina RK (1986) Pharmacokinetics of phenobarbitone in protein energy malnutrition. Dev Pharmacol Ther 9 (5):317-22. Pubmed
Yska JP, Essink GW, Bosch FH, Lankhaar G, van Sorge AA (2000) Oral bioavailability of phenobarbital: a comparison of a solution in Myvacet 9-08, a suspension, and a tablet. Pharm World Sci 22 (2):67-71. Pubmed
Sahin M, Menache CC, Holmes GL, Riviello JJ (2003) Prolonged treatment for acute symptomatic refractory status epilepticus: outcome in children. Neurology 61 (3):398-401. Pubmed
Rosenow F, Arzimanoglou A, Baulac M (2002) Recent developments in treatment of status epilepticus: a review. Epileptic Disord 4 Suppl 2 ():S41-51. Pubmed
Hayashi K, Osawa M, Aihara M, Izumi T, Ohtsuka Y, Haginoya K et al. (2007) Efficacy of intravenous midazolam for status epilepticus in childhood. Pediatr Neurol 36 (6):366-72. Crossref Pubmed
Lampin ME, Dorkenoo A, Lamblin MD, Botte A, Leclerc F, Auvin S (2010) [Use of midazolam for refractory status epilepticus in children]. Rev Neurol (Paris) 166 (6-7):648-52. Crossref Pubmed
Crawford TO, Mitchell WG, Fishman LS, Snodgrass SR (1988) Very-high-dose phenobarbital for refractory status epilepticus in children. Neurology 38 (7):1035-40. Pubmed
DeWolfe JL, Knowlton RC, Beasley MT, Cofield S, Faught E, Limdi NA (2009) Hyperammonemia following intravenous valproate loading. Epilepsy Res 85 (1):65-71. Crossref Pubmed
Limdi NA, Knowlton RK, Cofield SS, Ver Hoef LW, Paige AL, Dutta S et al. (2007) Safety of rapid intravenous loading of valproate. Epilepsia 48 (3):478-83. Crossref Pubmed
Rossetti AO, Bromfield EB (2005) Efficacy of rapid IV administration of valproic acid for status epilepticus. Neurology 65 (3):500-1; author reply 500-1. Pubmed
Kirmani BF, Crisp ED, Kayani S, Rajab H (2009) Role of intravenous levetiracetam in acute seizure management of children. Pediatr Neurol 41 (1):37-9. Crossref Pubmed
Abend NS, Monk HM, Licht DJ, Dlugos DJ (2009) Intravenous levetiracetam in critically ill children with status epilepticus or acute repetitive seizures. Pediatr Crit Care Med 10 (4):505-10. Crossref Pubmed
Wilmshurst JM, Newton CR (2005) Withdrawal of older anticonvulsants for management of status epilepticus: implications for resource-poor countries. Dev Med Child Neurol 47 (4):219. Pubmed
Mastrangelo M, Celato A (2012) Diagnostic work-up and therapeutic options in management of pediatric status epilepticus. World J Pediatr 8 (2):109-15. Crossref Pubmed
World Health Organisation (2015, Feb 11). Antiepileptic drugs for acute convulsive seizures or status epilepticus in adults and children. Retrieved from http://www.who.int/mental_health/mhgap/evidence/epilepsy/q2/en/
World Health Organisation. (2015, Feb 11). WHO Model Lists of Essential Medicines. Retrieved from http://www.who.int/medicines/publications/essentialmedicines/en/index.html
Cite this article as: Wilmshurst JM.: Management of Children with Status Epilepticus. JICNA 2015 15:104. DOI: http://dx.doi.org/10.17724/jicna.2015.104
References
Zawadzki L, Stafstrom CE (2010) Status epilepticus treatment and outcome in children: what might the future hold? Semin. Pediatr. Neurol. 17 (3):201-5. Crossref Pubmed
Meldrum BS, Vigouroux RA, Brierley JB (1973) Systemic factors and epileptic brain damage. Prolonged seizures in paralyzed, artificially ventilated baboons. Arch Neurol 29 (2):82-7. Pubmed
Lowenstein DH, Bleck T, Macdonald RL (1999) It's time to revise the definition of status epilepticus. Epilepsia 40 (1):120-2. Pubmed
Chin RF, Neville BG, Peckham C, Wade A, Bedford H, Scott RC (2008) Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol 7 (8):696-703. Crossref Pubmed
Scott RC, Surtees RA, Neville BG (1998) Status epilepticus: pathophysiology, epidemiology, and outcomes. Arch Dis Child 79 (1):73-7. Pubmed
Holtkamp M, Othman J, Buchheim K, Meierkord H (2005) Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry 76 (4):534-9. Crossref Pubmed
Schreiber JM, Gaillard WD (2011) Treatment of refractory status epilepticus in childhood. Curr Neurol Neurosci Rep 11 (2):195-204. Crossref Pubmed
Haafiz A, Kissoon N (1999) Status epilepticus: current concepts. Pediatr Emerg Care 15 (2):119-29. Pubmed
Singh RK, Stephens S, Berl MM, Chang T, Brown K, Vezina LG et al. (2010) Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology 74 (8):636-42. Crossref Pubmed
Fountain NB (2000) Status epilepticus: risk factors and complications. Epilepsia 41 Suppl 2 ():S23-30. Pubmed
Lacroix J, Deal C, Gauthier M, Rousseau E, Farrell CA (1994) Admissions to a pediatric intensive care unit for status epilepticus: a 10-year experience. Crit Care Med 22 (5):827-32. Pubmed
Newton CR (2009) Status epilepticus in resource-poor countries. Epilepsia 50 Suppl 12 ():54-5. Crossref Pubmed
Sahin M, Menache CC, Holmes GL, Riviello JJ (2001) Outcome of severe refractory status epilepticus in children. Epilepsia 42 (11):1461-7. Pubmed
Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC et al. (2006) Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 368 (9531):222-9. Crossref Pubmed
Riviello JJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K et al. (2006) Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 67 (9):1542-50. Crossref Pubmed
Kurtz P, Hanafy KA, Claassen J (2009) Continuous EEG monitoring: is it ready for prime time? Curr Opin Crit Care 15 (2):99-109. Crossref Pubmed
Subbaswamy A, Hsu AA, Weinstein S, Bell MJ (2009) Correlation of cerebral Near-infrared spectroscopy (cNIRS) and neurological markers in critically ill children. Neurocrit Care 10 (1):129-35. Crossref Pubmed
Scott RC, Besag FM, Neville BG (1999) Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet 353 (9153):623-6. Crossref Pubmed
Jeannet PY, Roulet E, Maeder-Ingvar M, Gehri M, Jutzi A, Deonna T (1999) Home and hospital treatment of acute seizures in children with nasal midazolam. Eur J Paediatr Neurol 3 (2):73-7. Crossref Pubmed
Loddenkemper T, Goodkin HP (2011) Treatment of pediatric status epilepticus. Curr Treat Options Neurol 13 (6):560-73. Crossref Pubmed
Appleton R, Macleod S, Martland T (2008) Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev (3):CD001905. Crossref Pubmed
Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst. Rev. 2008 Jul 16;(3)(3):CD001905.
Prasad A, Williamson JM, Bertram EH (2002) Phenobarbital and MK-801, but not phenytoin, improve the long-term outcome of status epilepticus. Ann Neurol 51 (2):175-81. Pubmed
Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ et al. (1998) A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 339 (12):792-8. Crossref Pubmed
Wilmshurst JM, van der Walt JS, Ackermann S, Karlsson MO, Blockman M (2010) Rescue therapy with high-dose oral phenobarbitone loading for refractory status epilepticus. J Paediatr Child Health 46 (1-2):17-22. Crossref Pubmed
Syed GB, Sharma DB, Raina RK (1986) Pharmacokinetics of phenobarbitone in protein energy malnutrition. Dev Pharmacol Ther 9 (5):317-22. Pubmed
Yska JP, Essink GW, Bosch FH, Lankhaar G, van Sorge AA (2000) Oral bioavailability of phenobarbital: a comparison of a solution in Myvacet 9-08, a suspension, and a tablet. Pharm World Sci 22 (2):67-71. Pubmed
Sahin M, Menache CC, Holmes GL, Riviello JJ (2003) Prolonged treatment for acute symptomatic refractory status epilepticus: outcome in children. Neurology 61 (3):398-401. Pubmed
Rosenow F, Arzimanoglou A, Baulac M (2002) Recent developments in treatment of status epilepticus: a review. Epileptic Disord 4 Suppl 2 ():S41-51. Pubmed
Hayashi K, Osawa M, Aihara M, Izumi T, Ohtsuka Y, Haginoya K et al. (2007) Efficacy of intravenous midazolam for status epilepticus in childhood. Pediatr Neurol 36 (6):366-72. Crossref Pubmed
Lampin ME, Dorkenoo A, Lamblin MD, Botte A, Leclerc F, Auvin S (2010) [Use of midazolam for refractory status epilepticus in children]. Rev Neurol (Paris) 166 (6-7):648-52. Crossref Pubmed
Crawford TO, Mitchell WG, Fishman LS, Snodgrass SR (1988) Very-high-dose phenobarbital for refractory status epilepticus in children. Neurology 38 (7):1035-40. Pubmed
DeWolfe JL, Knowlton RC, Beasley MT, Cofield S, Faught E, Limdi NA (2009) Hyperammonemia following intravenous valproate loading. Epilepsy Res 85 (1):65-71. Crossref Pubmed
Limdi NA, Knowlton RK, Cofield SS, Ver Hoef LW, Paige AL, Dutta S et al. (2007) Safety of rapid intravenous loading of valproate. Epilepsia 48 (3):478-83. Crossref Pubmed
Rossetti AO, Bromfield EB (2005) Efficacy of rapid IV administration of valproic acid for status epilepticus. Neurology 65 (3):500-1; author reply 500-1. Pubmed
Kirmani BF, Crisp ED, Kayani S, Rajab H (2009) Role of intravenous levetiracetam in acute seizure management of children. Pediatr Neurol 41 (1):37-9. Crossref Pubmed
Abend NS, Monk HM, Licht DJ, Dlugos DJ (2009) Intravenous levetiracetam in critically ill children with status epilepticus or acute repetitive seizures. Pediatr Crit Care Med 10 (4):505-10. Crossref Pubmed
Wilmshurst JM, Newton CR (2005) Withdrawal of older anticonvulsants for management of status epilepticus: implications for resource-poor countries. Dev Med Child Neurol 47 (4):219. Pubmed
Mastrangelo M, Celato A (2012) Diagnostic work-up and therapeutic options in management of pediatric status epilepticus. World J Pediatr 8 (2):109-15. Crossref Pubmed
World Health Organisation (2015, Feb 11). Antiepileptic drugs for acute convulsive seizures or status epilepticus in adults and children. Retrieved from http://www.who.int/mental_health/mhgap/evidence/epilepsy/q2/en/
World Health Organisation. (2015, Feb 11). WHO Model Lists of Essential Medicines. Retrieved from http://www.who.int/medicines/publications/essentialmedicines/en/index.html
Cite this article as: Wilmshurst JM.: Management of Children with Status Epilepticus. JICNA 2015 15:104. DOI: http://dx.doi.org/10.17724/jicna.2015.104